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Environmental Modifications (EMods), Vehicle Modifications (VMods), Adaptive and Assistive Technology (AT), and Non-Emergency Medical Transportation

Recent Updates

For HHCM/C-YES notification to the NYS and for questions or support contact: EModVModAT@health.ny.gov

EFFECTIVE 9/1/21: Only 21 OHIP ADM-01 forms to be accepted and processed.
On June 9, 2021 NYS Department of Health hosted two webinars regarding the Assistive Technology (AT), Environmental Modifications (EMod), and Vehicle Modifications (VMod) Request Process. As mentioned during the webinars, NYS Department of Health has issued an updated Description and Cost Projection Form and Final Cost Form. Starting September 1, 2021 NYSDOH will no longer accept request submissions on previous versions of the Description and Cost Projection Form or Final Cost Form. Only the most recent versions, issued April 2021, of the Description and Cost Projection Form and Final Cost Form will be accepted.

EMod/VMod/AT General Information

• Children's Waiver EMod, VMod, AT Providers and Evaluators (XLSX) - July 18, 2022
• Children's Waiver EMod, VMod, AT LDSS Contact list (XLSX) - July 21, 2021
• Children's Waiver Environmental Modification, Vehicle Modification, and Assistive Technology for Transition to Medicaid Managed Care (PDF) - October 1, 2019

Financial Management Services (FMS) Guidance, Policies, and Forms

• Transition Process of Medicaid Managed Care Plans' Environmental and Vehicle Modification and Assistive and Adaptive Technology Requests to Financial Management Servicer - (PDF) - (Recording) - June 24, 2024
• DOH-5808 - Participant/Parent/Caregiver Agreement for EModVModAAT (PDF)
• GIS 24 MA-03 - Children's Waiver Environmental Modifications, Vehicle Modifications, and Adaptive and Assistive Technology Authorization - (PDF) - June 3, 2024
• Financial Management Services Process for Care Managers - (PDF) | Recording (YouTube) - March 7, 2024
• Financial Management Services Process for Local Dept. of Social Services (LDSS) - (PDF) | Recording (YouTube) - March 7, 2024
• LDSS Transition and Retention Project Tracker - (Web) - (XLSX) - August 29, 2024
• Children's Waiver EMod, VMod, and AT Transition to Financial Management Services - (PDF) - February 20, 2024

Non-FMS Guidance, Policies, and Forms

EMod/VMod/AT Requirements and Guidance

• Architectural Drawing Guidance for Children's Waiver Environmental Modifications (PDF) - November 22, 2022
• EMod, VMod, AT Frequently Asked Questions (PDF) - October 2021
• Pre-Project Evaluation Guidance (PDF) - June 2021
  • Attachment A: Sample Pre-Projection Evaluation (PDF) - June 2021

  EMod/VMod/AT Policies, Forms, and ADMs for HHCM/CYES/LDSS

  • Parent/Caregiver Info Sheet- Vehicle Modifications (PDF) - May 2023
  • Parent/Caregiver Info Sheet- Adaptive and Assistive Technology (PDF) - November 2022
  • Parent/Caregiver Info Sheet- Environmental Modifications (PDF) - November 2022
  • EMod, VMod, and AT Authorization Policy for Care Managers/CYES #CW00012 - Updated November 2022
  • 21ADM-01 Children's Waiver Adaptive and Assistive Technology, Environmental Modifications, and Vehicle Modifications Authorization (PDF)
    • Attachment 1: Guidelines for Authorizing Adaptive and Assistive Technology (PDF)
    • Attachment 2: Guidelines for Authorizing Environmental Modifications (PDF)
    • Attachment 3: Guidelines for Authorizing Vehicle Modifications (PDF)
    • Attachment 4: Description and Cost Projection Form (PDF)
    • Attachment 5: Notice of Decision to Authorize or Deny Assistive and Adaptive Technology, Environmental Modification, and Vehicle Modification (PDF)
    • Attachment 6: Final Cost Form (PDF)
    • Attachment 7: Requirements for Requesting Special Project Vouchering (SPV) Funds (PDF)
    • Attachment 8: Pre-Project Evaluation Payment Request Form (PDF)
    • Attachment 9: Guidance on Environmental Modifications to Support Behaviorally Health Challenged Members (PDF)

    Webinars

    • Adaptive and Assistive Technology: Process the Possibilities - PDF | Recording (YouTube) - May 4, 2023
    • EMod, VMod, AT Process Reminders and Best Practices - PDF | Recording (YouTube) - November 21, 2022
    • EMod, VMod, AT Request Process for the LDSS - PDF | Recording (YouTube) - May 2021
    • EMod, VMod, AT Request Process for the HHCM/C-YES - PDF | Recording (YouTube) - May 2021

    Non-Medical Transportation

    • NMT materials are available on the eMedNY site under the Transportation Manual on the Transportation page found HERE (External Link)
    • Non-Medical Transportation (NMT) Authorization Process for Child/Youth in FFS (External Link)
    • NYS DOH Plan of Care Grid for Non-Medical Transportation for Children's Home and Community Based Services (HCBS) (External Link)
    • NMT Service Description (External Link)

    Managed Care Resources

    • MCO Plan Matrix- Contact information for MMCPs (External Link)

    Medicaid Managed Care Complaints can be sent to NYS DOH Complaint team at: 1-800-206-8125 or email: managedcarecomplaint@health.ny.gov